系统保留盆腔自主神经广泛性子宫切除术的临床观察

Preliminary clinical study of systematic nerve-sparing radical hysterectomy

目的：探索系统保留盆腔自主神经的广泛性子宫切除术（systematic nerve sparing radical hysterectomy，SNSRH）对术后膀胱、直肠及性功能的保护作用。方法：选取2007年11月～2009年4月宁夏医科大学附属医院收治的44例宫颈癌及子宫内膜癌患者，A组24例行SNSRH，B组20例行传统根治性子宫切除术，观察SNSRH成功率，两组术后膀胱、直肠和性功能情况。结果：（1）A、B两组严格遵循Ⅲ型子宫切除术标准，手术切除范围无差异；（2）30例行SNSRH，成功保留盆腔自主神经（PAN）24例，失败6例，成功率80％；（3）A、B组平均手术时间、术中出血量差异无统计学意义；A、B组平均留置尿管时间、术后残余尿量、排气排便时间差异有统计学意义（P〈0．05）；（4）A组术后性功能障碍发生率明显低于B组，差异有统计学意义（P〈0．05）。结论：系统保留PAN的广泛性子宫切除术对术后膀胱、直肠及性功能的恢复有一定的保护作用。

Objective ：To investigate the feasibility of the technique for sparing the pelvic autonomic nerve（PAN） on postsurgical bladder, rectum and sexual function. Methods：Forty four cases of cervical cancer and endometrial cancer patients between November 2007 and April 2009 in Ningxia Medical University Hospital were selected. All cases were divided into two groups（group A and B）. 24 cases of group A underwent SNSRH and 20 cases of group B underwent radical hysterectomy. The success rate of SNSRH and their bladder, rectum and sexual function after the operation were observed. Results： （ 1 ） There was no difference between group A and group B in the excision extent, both of which according to the standard of III hysterectomy. （ 2 ） There were 24 cases of successful retention of PAN and six cases of failure, the success rate of 80%. （3） There were no significant differences between group A and group B of the average operation time and bleeding was during the operation;there were significant differences belween group A and group B of the media duration of postoperative catheterization, the postoperative residual urine volume,the first exhaust time and the first stool time（P〈0.05）. （4）The incidence of sexual dysfunction of patients in group A was significantly lower than that of group B, with a significant difference （ P〈0.05 ）. Conclusion： During radical hysterectomy, sparing the PAN can benefit the bladder,rectum and sexual function.